Abstract
Hepatic manifestations of systemic lupus erythematosus (SLE) have been reported to be less common than renal involvement and confined to mild biochemical or histological abnormalities. Since a concept of “autoimmune hepatitis”, characterized by the presence of chronic active hepatitis (CAH) concomitant with positive LE cells, was proposed by Mackay in 1956, discrimination between hepatic involvement of SLE (“hepatic lupus”) and autoimmune hepatitis (or “lupoid hepatitis”) has become important on occasion. However, many epidemiological or immunopathological studies hasn't be able to disclose significant differences between two diseases.
We reported a case of CAH associated with typical profiles of immunological abnormalities in SLE. Although this case certainly fulfilled the proposed criteria for lupoid hepatitis, observations listed below raised the possibility that CAH might be accompanied by SLE in some occasions; 1) More than four of the manifestations listed in ARA's criteria for SLE were definitely present in our patient. 2) Anti-ds DNA, anti-Sm and anti-RNP antibodies were present in his serum. 3) Neither anti-smooth muscle antibody nor anti-mitochondria antibody was present. 4) Marked reduction of hemolytic complement activity was associated with depressed serum complement components (C 3, C 4), indicating the activation of classical complement pathway.
Clinicoimmunological difference between two diseases should be further investigated and elucidated not only by hepatologists but by immunologists.
